剖宫产术中行子宫肌瘤剔除术的临床应用

目的探讨临床剖宫产术中同时行子宫肌瘤剔除术的临床疗效和安全性。方法选取2011年月至2011年12月期间收治的剖宫产术中同时行子宫肌瘤剔除术的80例妊娠合并子宫肌瘤患者为研究组,并选取同期仅进行剖宫产术的80例妊娠合并子宫肌瘤患者为对照组,观察两组的应用效果。结果研究组手术时间明显高于对照组,差异有统计学意义(P<0.05)。研究组和对照组的术中出血量、产后出血量、缩宫素用量比较,差异无统计学意义(P>0.05)。研究组和对照组术后血红蛋白、住院时间、肛门排气时间比较,差异无统计学意义(P>0.05)。研究组的并发症发生率为2.5%,对照组的并发症发生率为3.8%,差异无统计学意义(P>0.05)。结论临床中妊娠合并有子宫肌瘤的患者在实施剖宫产术中同时行子宫肌瘤剔除术是可行的,值得临床应用与推广。     

剖宫产术中行子宫肌瘤剔除术160例临床分析

目的 探讨剖宫产同时行子宫肌瘤剔除术的可行性.方法 回顾性分析160例剖宫产术中同时行子宫肌瘤剔除术的产妇,与同期100例行单纯剖宫产术的产妇作为对照,比较两组的手术时间、出血量、住院天数.按肌瘤大小分为>8cm肌瘤组与≤8cm肌瘤组,对其术中出血量、手术时间及术后住院天数进行比较.结果 研究组手术操作时间较对照组延长,差异有统计学意义(P<0.05);但两组的术中出血量和术后住院天数比较,差异均无统计学意义(P>0.05).>8cm肌瘤组与≤8cm肌瘤组相比较,手术时间明显延长,术中出血量显著增多(P<0.05).结论 根据患者的具体情况,选择性地行剖宫产同时子宫肌瘤剥除术是安全可行的,对部位特殊的子宫肌瘤及大型子宫肌瘤的处理须谨慎.     

剖宫产术中行子宫肌瘤剔除术160例临床分析

目的：探讨剖宫产同时行子宫肌瘤剔除术的可行性。方法：回顾性分析160例剖宫产术中同时行子宫肌瘤剔除术的产妇,与同期100例行单纯剖宫产术的产妇作为对照,比较两组的手术时间、出血量、住院天数。按肌瘤大小分为〉8cm肌瘤组与≤8cm肌瘤组,对其术中出血量、手术时间及术后住院天数进行比较。结果：研究组手术操作时间较对照组延长,差异有统计学意义（P〈0.05）;但两组的术中出血量和术后住院天数比较,差异均无统计学意义（P〉0.05）。〉8cm肌瘤组与≤8cm肌瘤组相比较,手术时间明显延长,术中出血量显著增多（P〈0.05）。结论：根据患者的具体情况,选择性地行剖宫产同时子宫肌瘤剥除术是安全可行的,对部位特殊的子宫肌瘤及大型子宫肌瘤的处理须谨慎。     

腹腔镜下子宫肌瘤剔除术和传统开腹手术的效果比较

目的 比较腹腔镜下子宫肌瘤剔除术和传统开腹手术的效果.方法 按照手术方案不同将94例子宫肌瘤患者均分为实验组和对照组,实验组患者采用腹腔镜子宫肌瘤剔除术,对照组采用传统开腹子宫肌瘤剔除术,比较两组治疗效果.结果 实验组患者术手术时间、术中出血量、肛门排气时间、住院时间均显著优于对照组,差异具有显著性(P＜0.05);两组患者肌瘤剔除数目及术后肌瘤残留和复发率比较,差异无统计学意义(P＞0.05);实验组患者切口甲级愈合率显著高于对照组,并发症发生率显著低于对照组,差异具有显著性(P＜0.05);实验组患者术后随访24个月妊娠率显著高于对照组,差异具有显著性(P＜0.05);两组肌瘤数目＜4个患者肌瘤残留和复发率均显著低于同组肌瘤数目≥4个者,差异具有显著性(P＜0.05).结论 腹腔镜下子宫肌瘤剔除术肌瘤剔除数目及术后肌瘤残留和复发率与传统开腹手术相近,但围术期情况优于传统开腹手术,临床应用价值更高.     

剖宫产术中子宫肌瘤的处理及结局分析

目的:探讨剖宫产术中剔除子宫肌瘤的安全性.方法:对56例妊娠合并子宫肌瘤病例剖宫产子宫肌瘤剔除方法进行分析,正常剖官产术做对照比较预后.结果:单纯子宫肌瘤剔除组(剔除I组)与对照组比较,术中出血量增加,手术时间延长,差异有统计学意义(P<0.01).先结扎子宫动脉后剔除子宫肌瘤组(剔除Ⅱ组)与对照组比较,手术时间延长(t=3.71,P<0.01、),术中出血量无差异(t=1.49,P>0.05),三组产后出血发生率、产科子宫切除、术后病率、住院时间两两比较差异无统计学意义.结论:剖宫产术中剔除子宫肌瘤术中出血量增加,应加强对出血预测,必要时行子宫动脉结扎,减少术中出血量.     

妊娠合并子宫肌瘤同期行剖宫产术和子宫肌瘤剔除术的疗效观察

目的探讨妊娠合并子宫肌瘤患者同期行剖宫产术和子宫肌瘤剔除术的效果。方法选取2017年11月至2019年11月间北京市平谷区医院收治的68例妊娠合并子宫肌瘤患者,根据治疗方法不同进行分组,采用剖宫术治疗的34例患者纳入对照组,采用剖宫产术联合子宫肌瘤剔除术治疗的34例患者纳入研究组。比较两种治疗方法实际应用效果的差异性。结果相较于对照组,研究组手术时间更长,差异有统计学意义(P <0. 05);两组患者疼痛评分、术中出血量、住院时间及肛门排气时间比较,差异无统计学意义(P>0. 05)。两组患者月经恢复时间、产后出血量、恶露持续时间及产后并发症比较,差异无统计学意义(P> 0. 05)。两组新生儿身长、5min Apgar评分、体质量及新生儿窒息比较,差异无统计学意义(P>0. 05)。结论在妊娠合并子宫肌瘤临床治疗中,可同期实施剖宫产术和子宫肌瘤剔除术,手术安全性较高,母婴健康状况较好。     

妊娠合并子宫肌瘤235例临床分析

[目的]探讨刮宫产术中子宫肌瘤剔除的可行性。[方法]回顾性分析235例妊娠合并子宫肌瘤产妇，在剖宫产同时行子宫肌瘤剔除，并与170例单纯剖宫产的无合并子宫肌瘤产妇的临床资料作对照。[结果]观察组与对照组对象年龄、孕次、孕周等方面无统计学意义（P〉0．05）。两组出血量、外周血血红蛋白下降值、手术时间、切口愈合情况均无统计学意义（P〉0.05）。[结论]妊娠合并子宫肌瘤患者剖宫产率高．大部分病例可在剖宫产同时仃子宫肌瘤剔除术，但对于直径〉5cm的肌壁间或黏膜下肌瘤．需做好充分的术前准备，保证手术的安全。     

剖宫产术中子宫肌瘤的处理及结局分析

目的：探讨剖宫产术中剔除子宫肌瘤的安全性.方法：对56例妊娠合并子宫肌瘤病例剖宫产子宫肌瘤剔除方法进行分析,正常剖官产术做对照比较预后.结果：单纯子宫肌瘤剔除组（剔除I组）与对照组比较,术中出血量增加,手术时间延长,差异有统计学意义（P〈0.01）.先结扎子宫动脉后剔除子宫肌瘤组（剔除Ⅱ组）与对照组比较,手术时间延长（t=3.71,P〈0.01、）,术中出血量无差异（t=1.49,P〉0.05）,三组产后出血发生率、产科子宫切除、术后病率、住院时间两两比较差异无统计学意义.结论：剖宫产术中剔除子宫肌瘤术中出血量增加,应加强对出血预测,必要时行子宫动脉结扎,减少术中出血量.     

快速康复护理对腹腔镜子宫肌瘤剔除术患者的效果观察

目的探讨腹腔镜子宫肌瘤剔除术患者采用快速康复护理理念的临床效果。方法选取2019年1月至2020年7月间湖南省妇幼保健院收治的行腹腔镜子宫肌瘤剔除术治疗的300例患者,采用随机抽签法分为观察组和对照组,每组150例。观察组患者采用快速康复护理理念,对照组患者采用常规护理,比较两组患者各项指标恢复进度及并发症发生率。结果观察组患者手术时间和住院时间较对照组更短,术中出血量更少,术后肛门排气时间更快,差异均有统计学意义(均P<0.05)。观察组患者术后并发症发生率为1.3%,低于对照组的6.7%,差异有统计学意义(P<0.05)。结论行腹腔镜子宫肌瘤剔除术患者采用快速康复护理理念护理,可缩短手术时间,减少术中出血量及并发症,患者恢复快。     

妊娠合并子宫肌瘤235例临床分析

[目的]探讨刮宫产术中子宫肌瘤剔除的可行性。[方法]回顾性分析235例妊娠合并子宫肌瘤产妇，在剖宫产同时行子宫肌瘤剔除，并与170例单纯剖宫产的无合并子宫肌瘤产妇的临床资料作对照。[结果]观察组与对照组对象年龄、孕次、孕周等方面无统计学意义（P〉0．05）。两组出血量、外周血血红蛋白下降值、手术时间、切口愈合情况均无统计学意义（P〉0.05）。[结论]妊娠合并子宫肌瘤患者剖宫产率高．大部分病例可在剖宫产同时仃子宫肌瘤剔除术，但对于直径〉5cm的肌壁间或黏膜下肌瘤．需做好充分的术前准备，保证手术的安全。     

Experience with Impedance Phlebography Compared with Venography

Venography is a particularly reliable method for the diagnosis of deep venous thrombosis but is not suitable as a screening test. Impedance phlebography represents another attempt to discover a simple, non-invasive and reliable method of detecting deep venous thrombosis. It does not, however, meet these criteria.     

Compliance with guidelines and correlation with outcome in patients with advanced germ-cell tumours

PurposeTo evaluate prior compliance with guidelines in patients treated with salvage chemotherapy for advanced germ-cell tumours (GCT).Patients and methodsData concerning the initial management of patients requiring salvage chemotherapy for GCT at Institut Gustave Roussy between 2000 and 2010 were obtained and correlated with recommendations for treatment. Criteria of non-compliance were defined based on guidelines. Compliance with guidelines, predictive factors for non-compliance and the impact on outcome were analysed.ResultsAmong 82 patients treated in the salvage setting, guidelines to initial treatment were followed in only 41 cases (50%). The most common non-compliance criteria were non-adherence to the planned dose (16%), an inappropriate interval between first-line chemotherapy cycles (16%), the lack of post-chemotherapy surgery (16%) and a long interval to post-chemotherapy surgery (48%). Compliance with standard care was better in cancer centres than in other hospitals (private or public) (Odd Ratio (OR): 6.9, P = 0.001). A poor-risk status according to the International Germ Cell Cancer Collaborative Group (IGCCCG) was also predictive of compliance in univariate but not in multivariate analysis. No significant difference in outcome after salvage chemotherapy was observed. Patients relapsing after non-compliant first-line therapy tended to be more easily salvaged, which is consistent with the fact that their initial treatment was inadequate. Some of these relapses were therefore probably not due to true biologically refractory disease.ConclusionGuidelines for first-line treatment are adhered to in only half the patients requiring salvage chemotherapy. As the only predictive factor for non-compliance was the treating centre, centralisation of patients with GCT in well-trained hospitals should be recommended.     

Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer

BackgroundMethylnaltrexone (MNTX), a peripherally acting μ-opioid receptor (MOR) antagonist, is FDA-approved for treatment of opioid-induced constipation (OIC). Preclinical data suggest that MOR activation can play a role in cancer progression and can be a target for anticancer therapy.Patients and methodsPooled data from advanced end-stage cancer patients with OIC, despite laxatives, treated in two randomized (phase III and IV), placebo-controlled trials with MNTX were analyzed for overall survival (OS) in an unplanned post hoc analysis. MNTX or placebo was given subcutaneously during the double-blinded phase, which was followed by the open-label phase, allowing MNTX treatment irrespective of initial randomization.ResultsIn two randomized, controlled trials, 229 cancer patients were randomized to MNTX (117, 51%) or placebo (112, 49%). Distribution of patients' characteristics and major tumor types did not significantly differ between arms. Treatment with MNTX compared with placebo [76 days, 95% confidence interval (CI) 43–109 versus 56 days, 95% CI 43–69; P = 0.033] and response (laxation) to treatment compared with no response (118 days, 95% CI 59–177 versus 55 days, 95% CI 40–70; P < 0.001) had a longer median OS, despite 56 (50%) of 112 patients ultimately crossing over from placebo to MNTX. Multivariable analysis demonstrated that response to therapy [hazard ratio (HR) 0.47, 95% CI 0.29–0.76; P = 0.002) and albumin ≥3.5 (HR 0.46, 95% CI 0.30–0.69; P < 0.001) were independent prognostic factors for increased OS. Of interest, there was no difference in OS between MNTX and placebo in 134 patients with advanced illness other than cancer treated in these randomized studies (P = 0.88).ConclusionThis unplanned post hoc analysis of two randomized trials demonstrates that treatment with MNTX and, even more so, response to MNTX are associated with increased OS, which supports the preclinical hypothesis that MOR can play a role in cancer progression. Targeting MOR with MNTX warrants further investigation in cancer therapy.Clinical trials numberNCT00401362, NCT00672477.     

Living with secondary breast cancer: coping with an uncertain future with unmet needs

JOHNSTON S.R.D. (2010) European Journal of Cancer Care 19 , 561–563 Living with secondary breast cancer: coping with an uncertain future with unmet needs     

奥沙利铂联合羟基喜树碱治疗晚期胃癌临床分析

背景与目的体外及体内的临床研究显示,奥沙利铂(L-OHP)对多种肿瘤有显著抑制作用并与绝大多数抗癌药物具有相加或协同细胞毒作用.本文旨在观察L-OHP联合羟基喜树碱(HCPT)治疗晚期胃癌的近期疗效和患者耐受性,并与传统的化疗方案进行对比.方法采用非随机的分组方法将43例晚期胃癌患者分为L-OHP+HCPT方案组(治疗组)与Vp-16+CF+5-FU(ELF)方案组(对照组),其中男性28例,女性15例,中位年龄59岁,KPS评分≥60,观察两组的近期疗效和患者耐受性.结果治疗组24例有效率58.3%(14/24),对照组19例有效率42.1%(8/19).治疗组有效率高于对照组,两组差异有显著性(P<0.05).两组不良反应主要是骨髓抑制、恶心、呕吐、口腔炎、周围神经炎、静脉炎、脱发等,均在Ⅰ、Ⅱ度范围内.结论L-OHP联合HCPT方案治疗晚期胃癌疗效较好,不良反应可以耐受.     

Varicella-Zoster Virus Prophylaxis with Low-Dose Acyclovir in Patients with Multiple Myeloma Treated with Bortezomib

BackgroundVaricella-zoster virus (VZV) reactivation is a common complication in patients with multiple myeloma (MM) treated with bortezomib, with an incidence rate of 10%-60%. The aim of our study was to analyze the effect of acyclovir prophylaxis in this patient population.Patients and MethodsWe studied 98 consecutive patients with relapsed MM treated with bortezomib. Bortezomib 1.3 mg/m² was given on days 1, 4, 8, and 11 of a 21-day cycle. At first, patients did not receive any VZV prophylaxis, but because of the high incidence of VZV reactivation, VZV prophylaxis with acyclovir was implemented subsequently.ResultsA total of 11 patients treated with bortezomib did not have any VZV prophylaxis, and 4 of these 11 patients (36%) developed VZV reactivation in the form of herpes zoster. No VZV reactivations were observed in the 32 patients who received acyclovir 400 mg 3 times daily or the 55 patients who received acyclovir in a dose reduced to 400 mg once daily during bortezomib treatment.ConclusionVaricellazoster virus reactivation is a common and serious adverse effect of bortezomib treatment. Acyclovir 400 mg once daily is sufficient to protect from VZV reactivation in patients with MM treated with bortezomib.     

Costs associated with complications are lower with capecitabine than with 5‐fluorouracil in patients with colorectal cancer

BACKGROUND:

Capecitabine, an oral alternative to 5‐fluorouracil (5‐FU) in patients with colorectal cancer (CRC), has equal clinical efficacy and a favorable safety profile; however, its use may be limited because of unit cost concerns. In this study, the authors measured the cost of chemotherapy‐related complications during treatment with capecitabine‐ and 5‐FU–based regimens.

METHODS:

Patients with CRC who received at least 1 administration of capecitabine or 5‐FU during 2004 and 2005 were identified from the Thomson MarketScan research databases. Monthly frequency and cost for 23 complications were recorded. Logistic regression was used to predict complication probability. General linear models were used to predict monthly complication cost and total monthly expenditure.

RESULTS:

In total, 4973 patients with CRC met the inclusion criteria for this analysis. Although the most frequently observed complications were the same between capecitabine and 5‐FU (nausea and vomiting, infection, anemia, neutropenia, diarrhea), each was observed with greater frequency in 5‐FU–based regimens. The mean predicted monthly complication cost was significantly higher (by 136%) with 5‐FU monotherapy than with capecitabine monotherapy (difference, $601; 95% confidence interval [95% CI], $469‐$737). In addition, the mean predicted monthly complication cost for 5‐FU+oxaliplatin was higher than the cost with capecitabine plus oxaliplatin (difference, $1165; 95% CI, $892‐$1595). When acquisition, administration, and complication costs were taken into consideration, there were no significant differences in the total cost between capecitabine regimens and 5‐FU regimens.

CONCLUSIONS:

Capecitabine compared well with 5‐FU–based therapy in patients with CRC and was associated with lower complication rates and associated costs. Cancer 2009. © 2009 American Cancer Society.